Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks

Alteration in leukocyte activation has been implicated as an etiological factor in the development of chronic venous stasis ulcers (CVSU). The purpose of this study was to determine differences in expression of cell surface activation markers on circulating leukocytes and systemic, soluble, serum cytokine levels between healthy controls and patients with CVSU. Twenty-three patients were separated into two groups. Group I consisted of 12 healthy, adult, age-matched male patients with no venous disease. Group II consisted of 11 adult male patients with CVSU who underwent air plethysmography (APG) and duplex scanning to determine the severity of venous insufficiency. All patients had measurements of systemic, serum-based, soluble IL-1 beta, IL-2, IL-6, TNF-alpha, and beta 2 microglobulin levels. Using fluorescence flow cytometry, we measured the percentage of lymphocytes (CD3), monocytes (CD14), and granulocytes (CD15) expressing various cell surface activation markers. By APG and duplex scan, all group II patients exhibited venous insufficiency, with a mean venous filling index of 6.9 +/- 3.9 sec. Relative to group I, group II patients demonstrated a decreased expression of the CD3+/DR+ (13.3 +/- 1.5, P < or = 0.01) and CD3+/CD38+ (31.1 +/- 2.1, P < or = 0.04) markers on T-lymphocytes and an increased expression of CD14+/CD38+ (99.6 +/- 0.2, P < or = 0.008) markers on monocytes. Circulating neutrophils showed no evidence of activation. In addition, a significant elevation in the T-helper to T-suppressor ratio (2.9 +/- 0.6, P < or = 0.0001) between groups I and II was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Tutoring in problem-based learning: perceptions of teachers and students

This study examined teacher and student perceptions during the first 2 years of a complete transition from a conventional to a problem-based learning (PBL) curriculum at Dalhousie University. Teaching staff who had tutored in the two pre-clinical years (n = 88) completed a questionnaire at the end of the 1993-94 academic year, and student assessments of their tutors were collated for all nine units (n = 597). Seven research questions were addressed in the study which examined the faculty, student and administrative aspects of tutoring. The results showed that faculty tutors rated PBL more highly than traditional medical school methods on eight of the nine items. Teaching staff were very satisfied with their tutoring experience, but expressed a need for further training in group facilitation, questioning, handling 'difficult' situations and evaluating students. They reported that their workload outside tutorials was cut almost in half in their second year of tutoring. Students expected a tutor to be a skilled group facilitator who would guide them in their learning, while helping to maintain a positive group climate. They did not want the tutor to teach the content as they perceived the task of learning to be their responsibility. Several major administrative factors affected tutors' and students' perceptions of tutorials, including: changing tutorial group composition and tutor every 8-10 weeks; team tutoring; end-of-unit exam; conflicting demands of basic science 'vertical' units and ongoing 'horizontal' units; departmental budgetary requirements for basic medical education; recognition of tutoring in promotion and tenure decisions; and recruitment of tutors.     

Nursing home residents functional ability and perceptions of choice

1. Nursing home residents have the right to be involved in decision making relative to their care, which researchers have demonstrated has a positive effect on residents. 2. The authors designed a study to explore discrepancies between residents' perceptions of choice and the amount of choice preferred and their relationship to self-care abilities and functional abilities in nursing home residents. 3. The results indicate that residents desired more choice than they felt they were given, but that this difference was not related to their perceptions of their self-care abilities. As residents' functional abilities increased, actual choice as well as desired choice increased slightly. 4. Nurses should structure the nursing home's approach to residents so that choice is maximized within the constraints of the institution.     

Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons

BACKGROUND: Laparoscopic surgery adapts poorly to apprenticeship models for general surgical training. Standardized skill acquisition and validation programs, targeted performance goals, and a supervised, enforced, skill-based curriculum that readily can be shared between trainee and instructor must replace the observation and incremental skill-acquisition model used in an open surgical environment. The Yale Laparoscopic Skills and Suturing Program was used to develop a data bank for objective evaluation of dexterity and suturing skills for laparoscopic surgical training. The current study compares trainee and senior surgeon performance in this standardized training program. OBJECTIVE: To compare objectively evaluated laparoscopic surgical skills and suturing capability of senior surgeons and of residents after they have completed the same standardized training regimen. METHODS: Two hundred ninety-one trained surgeons performed 8730 standardized laparoscopic dexterity drills and 2910 intracorporeal suturing exercises in the Yale Laparoscopic Skills and Suturing Program. Their performance was supervised by an instructor who recorded performance and timing of the tasks in a 2 1/2-day program. Ninety-nine residents performed the same drills and exercises the same number of times and followed the same technique for intracorporeal suturing. Percentile graphs were prepared for each type of drill and suturing exercise to allow comparison of levels of achievement among different training groups. RESULTS: The performance of the residents was the same as that of trained surgeons for the rope pass drill and the suturing exercise. Residents in comparison with trained surgeons performed the triangle transfer drill faster and the new cup drop drill and old cup drop drill more slowly. There was no significant difference in performance between male and female residents. CONCLUSION: Basic skills relevant to laparoscopic performance can be acquired with a high level of competence in a brief course unrelated to prior surgical experience, sex, or age.     

The perceptions of line and senior managers in relation to occupational health issues

The present study demonstrated the change in interleukin-1 (IL-1) production of peritoneal macrophages during the estrous cycle in golden hamsters and discussed its possible roles in ovarian function. Macrophages were collected from the peritoneal cavity at 0900 h on various days of the estrous cycle and incubated for 6 h in the presence of ovine pituitary LH (500 ng/ml). The IL-1 concentration in the media was measured by bioassay with the A375S2 human melanoma cell line. The number of macrophages significantly (P < 0.01) increased on estrus and proestrus compared with diestrus 1 or diestrus 2. LH-induced production of IL-1 was also greater (P < 0.01) on proestrus (292 +/- 36 pg/10(6) cells/ ml) and estrus (222 +/- 30 pg/10(6) cells/ml) than on diestrus 1 (34 +/- 15 pg/10(6) cells/ml) or diestrus 2 (117 +/- 16 pg/10(6) cells/ml). To clarify the factor inducing the changes in peritoneal macrophages, hamsters were ovariectomized on diestrus 1, and 3 weeks later the animals were treated with s.c. injections of progesterone (200 micrograms/day), testosterone (100 micrograms/day), estradiol (10 micrograms/day) or sesame oil for three days. The hamsters were killed 24 h after the last injection, and the number and IL-1 producing capacity of macrophages were determined. The number of macrophages and their response to LH to produce IL-1 were increased significantly (P < 0.01) by estradiol treatment but not by progesterone or testosterone treatment. It was concluded that the peritoneal macrophages became more sensitive to LH to produce IL-1 on proestrus and estrus in cyclic hamsters, and that these changes in macrophages, probably induced by estradiol, would play important roles in ovarian function.     

The educational component of senior house officer posts: differences in the perceptions of consultants and junior doctors

The aims of this study were to elicit general practitioner (GP) trainee's perceptions of the educational structure of their hospital posts, to compare them with those of consultants who had GP trainees as senior house officers (SHOs) in their departments and to examine the use of educational objectives in the hospital component of vocational training for general practice. A confidential postal questionnaire was sent to all the GP trainees (165 doctors) in the hospital component of their vocational training schemes (VTS) for general practice in Trent Region and all the consultants (161 doctors) in Trent who had GP trainees in their SHO posts on that date. Responses were received from 136 trainees (82%) and 134 consultants (83%). Educational objectives were stated as existing in the SHO post by 31 trainees (23%) and by 62 consultants (46%). Of those doctors who said that objectives existed, 19 of the trainees (61%) and 40 of the consultants (65%) said that the objectives were useful. Only nine (29%) of the trainees who stated that educational objectives existed felt that they were being put into practice by senior staff, compared with 41 (66%) of consultants who had made that statement. Of all respondents, 113 trainees (87%) and 100 consultants (77%) agreed or strongly agreed that the use of educational objectives would be beneficial to the trainees. Only 10 (7%) of trainees said that they received no teaching in their current posts. Forty trainees (32%) and 88 consultants (67%) said that teaching took place in protected time. Both groups cited consultants as the member of staff giving the most teaching. Ninety-six consultants (73%) replied that it was possible for GP trainees to obtain study leave, but 102 trainees (75%) either had experienced difficulties in obtaining study leave or had not attempted to obtain study leave. Trainees and consultants differed appreciably in their perceptions of the amount of assessment and feedback which was provided for GP trainees. The use of educational objectives in the hospital component of vocational training was felt to be beneficial by both consultants and GP trainees. Consultants were more likely than trainees to report the use of educational objectives, protected teaching time, GP-orientated teaching, ability of trainees to attend VTS half-day release and the provision of assessment and feedback to trainees.     

Perceptions and responsibilities of clinical nurse specialists as educators

This study attempted to determine current involvement of clinical nurse specialists (CNS) in an educational function, their perceived adequacy for an educational role, and their future plans. About half of the 46 CNS who participated reported that acting as a consultant and providing assistance to nursing staff, and serving as a role model for nursing students were either very important or of utmost importance. Only 33% indicated that it was very important, or of utmost importance, to assist with clinical and theoretical teaching of nursing students. Although more than 50% of the respondents had taken courses in education, many felt inadequately prepared for their role. Only seven identified teaching as a current professional goal, while six respondents identified teaching as a five-year professional goal. Study implications relative to curricular pathways, course content, and academic advisement are discussed, as well as the need for a renewed emphasis on research in nursing education.     

La CLAve to increase psychosis literacy of Spanish-speaking community residents and family caregivers.

The authors developed and tested a 35-min psychoeducational program with the goal of increasing Spanish-speaking persons’ literacy of psychosis. The program uses popular cultural icons derived from music, art, and videos, as well as a mnemonic device—La CLAve (The Clue)—to increase (a) knowledge of psychosis, (b) efficacy beliefs that one can identify psychosis in others, (c) attributions to mental illness, and (d) professional help-seeking. Assessments were conducted before and after administering the program to both community residents (n = 57) and family caregivers of persons with schizophrenia (n = 38). For community residents, the authors observed increases across the 4 domains of symptom knowledge, efficacy beliefs, illness attributions, and recommended help-seeking. For caregivers, increases were observed in symptom knowledge and efficacy beliefs. La CLAve is a conceptually informed psychoeducational tool with a developing empirical base aimed at helping Spanish-speaking Latinos with serious mental illness obtain care in a timely manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinicians as caregivers: Role of attachment organization in treatment.

Examined the relationship between case managers' attachment organization and interventions used with clients who have serious psychopathological disorders. Adult Attachment Interviews were administered to 27 clients and their 18 case managers. Interviews were coded by means of Kobak's Q-set, which yields scores for secure–insecure and preoccupied–dismissing attachment strategies. Case managers were interviewed during each of 5 mo regarding their most recent interventions; interventions were coded for depth of intervention and attention to dependency needs. Compared with secure case managers, insecure case managers attended more to dependency needs and intervened in greater depth with preoccupied clients than they did with dismissing clients. Case managers who were more preoccupied intervened with their clients in greater depth than did case managers who were more dismissing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent perceptions as mediators of parenting: genetic and environmental contributions

Erwinia chrysanthemi causes soft rot on various plants. The maceration of plant tissues is mainly due to the action of endopectate lyases. The E. chrysanthemi strain 3937 produces eight endopectate lyases (PelA, PelB, PelC, PelD, PelE, PelI, PelL and PelZ) that are secreted by the Out pathway. The necrotic response elicited by the wild-type E. chrysanthemi strain on tobacco leaves is due to an extracellular protein secreted by the Out machinery. Purification of the active factor revealed that it corresponds to a pectate lyase presenting immunological cross-reaction with PelI. Analysis of pelI and out mutants indicated that the necrosis-inducing pectate lyase results from a post-translational modification of PelI occurring extracellularly both in culture media and in planta. This modification consists of the cleavage of 97 N-terminal amino acids by the extracellular proteases of E. chrysanthemi. The enzymatic properties of the maturated form, PelI-3, are not, or only weakly, modified. However, this maturation gives rise to a small size and basic form that is active as a defence elicitor in plants.     

Associations among perceptions of social support, negative affect, and quality of sleep in caregivers and noncaregivers.

The authors used structural equation modeling to examine associations among perceptions of negative affect, social support, and quality of sleep in a sample of caregivers (n = 175) and noncaregiver control participants (n = 169). The authors hypothesized that caregiver status would be related to sleep quality directly and also indirectly by way of negative affect and social support. This hypothesis was partially supported in that caregiving was found to be indirectly related to sleep quality. However, after accounting for the indirect effects of negative affect and social support, the direct effect of caregiving on sleep quality was no longer statistically significant. The structural model accounted for approximately 43% of the variance in sleep quality. The present findings may be useful in the development of successful sleep interventions for caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teachers' perceptions of their relationships with students: Effects of child age, gender, and ethnicity of teachers and children.

This study assessed the extent to which teachers' perceptions of their relationships with young students varied as a function of child and teacher characteristics in a large, demographically diverse sample of 197 preschool and kindergarten teachers and 840 children (mean age 4 yrs 7 mo old). Children were approximately evenly divided between boys and girls. Regression analyses were conducted to examine the relation between teachers' perceptions of their relationships with students and (a) teacher ethnicity, (b) child age, ethnicity, and gender, and (c) the ethnic match between teacher and child. Child age and ethnicity and teacher–child ethnic match were consistently related to teachers perceptions, explaining up to 27% of the variance in perceptions of negative aspects of the teacher–child relationship, specifically teacher–child conflict. When child and teacher had the same ethnicity, teachers rated their relationships with children more positively. The results are discussed in terms of classroom social processes related to children's adjustment and the measurement of teacher–child relationships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinical evaluation--difficulties experienced by sessional clinical teachers of nursing: a qualitative study

Evaluation of nursing students in the clinical field requires the clinical teacher to make judgements regarding student progress in a number of areas. In this study concepts of role theory, oppressed group behaviour and the ethics of caring emerged and were used as conceptual frameworks to interpret the data relating to the evaluation of undergraduate students. The number of experienced faculty available for clinical teaching and evaluation has become inadequate and a large number of casual or sessional clinical teachers are employed to teach students in the clinical field. Despite the well documented problems associated with clinical teaching and the use of inexperienced clinical teachers, sessional clinical teachers are nevertheless expected to evaluate student success in meeting the clinical requirements of the nursing course, often resulting in disparate decisions for students. A phenomenological study was carried out using unstructured interviews and written clinical scenarios, to explore the evaluation process from the perspective of the sessional clinical teachers. Research findings indicate that although the sessional clinical teachers were skilled at identifying student problems, they were reluctant to make difficult evaluation decisions, due to low self-esteem, role conflict and their ethic of caring. It seems that gender socialization, patriarchal dominance and apprenticeship training had effected their confidence in their own decision making. The implications of such findings are of concern for the ongoing credibility and integrity of nursing courses, as clinical teachers have an influence on the nursing profession through the preparation of its practitioners.     

Windstorms and important persons: personality characteristics of black educators

We have developed a simple model showing how the presence or obsence of Ca2+ can determine whether an uncurved or curved membrane surface is favored energetically. The model shows why fusion of vesicles with the presynaptic membrane is favored in the presence of calcium and why the budding off of vesicles is favored in the absence of calcium inside of the presynaptic membrane. The model accurately predicts the radius of a synaptic vesicle using known properties of lipids and suggests consequences of temperature change, varied stimulation rate and addition of calcium by artificial means on rates of transmitter release.     

Justice as a dependent variable: Subordinate charisma as a predictor of interpersonal and informational justice perceptions.

Research in the organizational justice literature has shown that interpersonal and informational justice are significant predictors of subordinate attitudes and behaviors. However, scholars have neglected to explore whether certain subordinate characteristics might be associated with managers' adherence to interpersonal and informational justice rules. The current authors' study tested a model, inspired by approach-avoidance perspectives (e.g., Gray, 1990), in which manager ratings of subordinate charisma influenced subordinate ratings of interpersonal and informational justice through the mechanisms of positive and negative sentiments (i.e., emotions felt by the manager toward the subordinate). A field study of 181 employees of a large national insurance company revealed partial support for this model. Structural equation modeling revealed that subordinate charisma was related to interpersonal justice perceptions, a relationship that was fully mediated by positive and negative sentiments. However, subordinate charisma was not associated with informational justice perceptions. These findings signal the potential utility in examining subordinate-based predictors of justice variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shiftwork and environment as interactive predictors of work perceptions.

Evidence suggests that the work environment may play a role in the elevated risk of adverse health outcomes among shiftworkers compared with dayworkers. Perceived work environment measures (physical stressors, job demand, job control, skill discretion, supervisor support, and safety perceptions) from UK oil industry personnel (N=1,867) were analyzed in relation to shiftwork (day/night rotation vs daywork) and objective work environment (onshore vs offshore). Age, education, job type, and negative affectivity were also included. The Environment × Shiftwork interaction was significant in multivariate tests and in 5 of the 6 univariate analyses. Onshore, shiftworkers perceived their environment significantly less favorably than dayworkers, but differences were less marked offshore. Results are discussed in relation to the demand-control-support model of work stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional diagnosis as a tool in rehabilitation: a comparison of teachers and other employees

Contractile cells in the mammalian lung develop in close association with the outgrowing stem bronchi. Fully differentiated smooth muscle cells are typically found in proximal regions, residing in the substantial muscular walls of the major airways and blood vessels. More distally, cells expressing markers of differentiated smooth muscle cells to a variable degree, and which may therefore possess contractile properties, are to be found scattered around the interstitium. We have investigated the temporal and spatial distribution of smooth muscle lineage markers (smooth muscle myosin mRNA) and of those indicative of contractile function (metavinculin mRNA) in the murine lung. In the smooth muscle layers of the bronchi and major blood vessels, these genes are expressed from the onset of pulmonary budding, concurrently with the appearance of alpha-smooth muscle actin and calponin proteins. During fetal development, smooth muscle-associated genes and proteins are restricted to this committed smooth muscle population. The first signs of myofibroblast or pericyte differentiation become manifest perinatally, when their expression of alpha-smooth muscle actin escalates. In the adult lung, such cells may be readily pin-pointed by their positive reaction for metavinculin mRNA, but, at maturity, they do not always coexpress alpha-smooth muscle actin.     

Spouses, adult children, and children-in-law as caregivers of older adults: A meta-analytic comparison.

The present meta-analysis integrates the results from 168 empirical studies on differences between caregiving spouses, adult children, and children-in-law. Spouses differ from children and children-in-law significantly with regard to sociodemographic variables; also, they provide more support but report fewer care recipient behavior problems. Spouse caregivers report more depression symptoms, greater financial and physical burden, and lower levels of psychological well-being. Higher levels of psychological distress among spouses are explained mostly—but not completely—by higher levels of care provision. Few differences emerge between children and children-in-law, but children-in-law perceive the relationship with the care recipient as less positive and they report fewer uplifts of caregiving. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Appraisal and goal processes as predictors of psychological well-being in bereaved caregivers.

Narratives of 30 caregivers were scored for appraisals and coping responses following the death of their partners from AIDS. Appraisals were identified as valenced beliefs, emotions, and goal outcomes, whereas coping responses included goals and plans of action. The proportion of positive appraisals predicted long-term goals and plans and psychological well-being at both bereavement and 12 months later. Positive appraisals were correlated with positive morale and positive states of mind. The latter were negatively correlated with partner-centered, short-term plans. Positive appraisals were negatively correlated with depressive mood. Caregivers, who reported proportionately more positive appraisals during caregiving and after the loss of their partner, were more likely to have future- and self-oriented goals and plans and to demonstrate positive well-being at bereavement and better recovery 12 months later than were those who reported more negative appraisals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)